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NPI Code Detail

MEDICARE: PAUL EDWARD MACMILLAN PA-C

MEDICARE: PAUL EDWARD MACMILLAN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1871547158
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL EDWARD MACMILLAN PA-C
Provider Business Mailing Address
First Line : 607 W MAIN ST
Second Line :
City : GRANGEVILLE
State : ID
Zip : 83530-1345
Country : US
Telephone Number : 208-983-8590
Fax Number :
Provider Business Practice Location Address
First Line : 607 W MAIN ST
Second Line :
City : GRANGEVILLE
State : ID
Zip : 83530-1345
Country : US
Telephone Number : 208-983-8590
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2006
Last Update Date : 04/27/2021

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Directions to “ PAUL EDWARD MACMILLAN PA-C” Practice Location

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